Prognostic factors in severe community-acquired pneumonia in patients without co-morbid illness.

Objectives: We wished to determine the prognostic factors and the impact of initial empirical antibiotic therapy on the outcome of severe community-acquired pneumonia in patients without underlying co-morbid illness.

Methodology: This is a retrospective record review of consecutive patients with severe community-acquired pneumonia who were divided into those with and without underlying co-morbid illness.

Results: There were 182 patients including 112 primary (no co-morbid illness) and 70 secondary (underlying co-morbid illness) pneumonias.

Bacteremic pneumococcal pneumonia in HIV-seropositive and HIV-seronegative adults.

Study Objectives: To compare the demographic, clinical, laboratory, and microbiological data, and the hospital course and outcome of HIV-seropositive and HIV-seronegative adults with bacteremic pneumococcal pneumonia.

Design: Retrospective observation study conducted over a 2-year period.

Setting: Academic teaching hospital attached to the University of the Witwatersrand, Johannesburg, South Africa.

Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery.

Purpose: To compare subcutaneous PCA tramadol with subcutaneous PCA morphine for postoperative pain relief after major orthopaedic surgery and for the incidence of side-effects.

Methods: In a double-blind randomised controlled study 40 patients (20 in each group) self-administered either tramadol or morphine for 72 hr after surgery via s.c.

Intraoperative bleeding: a mathematical model for minimizing hemoglobin loss.

Background: The rationale for intraoperative blood transfusion is often based on incorrect concepts and criteria.

Study Design And Methods: A mathematical model based on physiologic measures and describing the usual pattern of surgical blood loss is presented, and a theoretical means of minimizing intraoperative hemoglobin loss with hypervolemic hemodilution is proposed.

Results: Intraoperative hemoglobin loss is often overestimated especially in connection with high-volume blood loss.

Hydroxyzine premedication--does it provide better anxiolysis than a placebo?

Objectives: To determine how effective hydroxyzine is compared with a placebo in providing pre-operative anxiolysis in our hospital population, and to assess the anxiolytic effect of our pre-operative visit.

Design: Double-blind, randomised, prospective, controlled trial. Anxiety levels assessed with visual analogue scales (VAS), by patient and investigator.

IgG subclasses in previously healthy adult patients with acute community-acquired pneumonia.

Objective: To measure IgG antibody subclasses in previously healthy adult patients with acute community-acquired pneumonia, and to assess any association between differences of subtype levels and severity of illness or prognosis.

Design: Prospective study.

Setting: The intensive care unit (ICU) and general medical wards of Hillbrow Hospital, Johannesburg, an urban general hospital.

Cryptococcosis: an unusual cause of endobronchial obstruction.

We report the case of a 43 year old male patient, with normal immune function, who presented with right middle and lower lobe collapse. At bronchoscopy, a white lobulated lesion was seen, completely obstructing the origin of bronchus intermedius. Bronchial washings and biopsy of the lesion demonstrated cryptococcal organisms.

The aetiology of severe community-acquired pneumonia and its impact on initial, empiric, antimicrobial chemotherapy.

Of 259 patients admitted to an intensive care unit with severe acute community-acquired pneumonia, 173 had primary infections and 86 had secondary infections. The commonest organism isolated in each group was Streptococcus pneumoniae (51.3 and 36.

Aberrant common hepatic artery aneurysm. A case report.

A 45-year-old white woman was found on selective superior mesenteric artery angiography to have an aneurysm arising in an aberrant hepatic artery. The aberrant hepatic artery originated from the superior mesenteric artery, and was the only artery supplying the liver. The aneurysm was excised and continuity of the aberrant artery was restored by insertion of a short segment of autogenous long saphenous vein.

Neural arch tuberculosis: a morbid disease. Radiographic and computed tomographic findings.

We have reviewed the clinical features, together with the radiographs and computerised tomography, in 9 patients with tuberculosis of the vertebral body and neural arch. All presented with paraparesis or paraplegia. The morbidity associated with this disease is so serious that it is essential to have an accurate means of evaluating the lesion as early as possible.

Renal and neuromuscular respiratory failure--is this a syndrome associated with cantharidin poisoning?

Objective: To describe the clinical and laboratory features of patients with renal and neuromuscular respiratory failure due to suspected cantharidin poisoning.

Design: Retrospective record review of cases with neuromuscular respiratory failure.

Setting: Intensive Care Unit (ICU), Hillbrow Hospital, Johannesburg.

Oxidant-mediated ciliary dysfunction in human respiratory epithelium.

Exposure of human nasal ciliated epithelium to reactive oxidants generated by the enzymatic xanthine-xanthine oxidase superoxide/hydrogen peroxide (H2O2) and glucose-glucose oxidase H2O2-generating systems, or to reagent H2O2 or hypochlorous acid (HOCl) resulted in significant alterations in ciliary beating. The earliest change noted was the presence of ciliary slowing, progressing eventually to complete ciliary stasis in some areas. Ciliary dyskinesia was seen within the first hour, often from as early as 15 min after exposure of the cells to reactive oxidants.

Radiation therapy services in South Africa.

A survey of both private and public sector radiation therapy facilities in South Africa shows that they are available in only 7 major urban centres. About 20,000 cases are treated yearly by 58 therapists and 190 therapy radiographers, with 37 megavoltage and 24 X-ray machines. Brachytherapy, imaging and planning equipment is also inadequate.

Diagnosis and management of paediatric brainstem gliomas.

A review of paediatric brainstem gliomas (BSGs) treated in the Department of Radiation Oncology of the University of the Witwatersrand teaching hospital group is presented. Eleven patients between the ages of 4 years and 9 years were seen in the period 1982-1992. Of these cases, 9 were diffuse, 1 focal and 1 exophytic; the radiological features classifying these primary brainstem tumours are described.

Factors associated with airway colonisation and invasion due to Klebsiella spp.

The clinical significance of a heavy growth of Klebsiella spp. in sputum was studied in 54 patients. All but 3 patients had significant factors potentially associated with respiratory tract colonisation or invasion.

Introducing a patient-controlled analgesia-based acute pain relief service into southern Africa--the first 10 months.

The 10 months after the introduction of the first acute pain relief service (APRS) in southern Africa is described. Seven hundred patients were treated with morphine by means of patient-controlled analgesia (PCA), administered to patients after major surgery or extensive burns via the intravenous (IV) or subcutaneous (SC) route. The efficacy, safety and resource implications were assessed.

A hypermetabolic reaction during anaesthesia and surgery. A case report.

A young man underwent anaesthesia and surgery after multiple fractures. After 2 hours of anaesthesia, the patient developed hypercapnia, acidosis, hyperpyrexia and mild muscle rigidity. He was treated for malignant hyperthermia.

A study of immunoglobulin G subclass levels in black and white patients with various forms of obstructive lung disease.

The association of various respiratory disorders with disturbances in immunoglobulin G (IgG) subclass levels is increasingly being recognised. This was a prospective study of the IgG subclass levels in 71 patients (37 white, 34 black) with various respiratory disorders associated with obstructive airways disease. Ten white patients with adult cystic fibrosis were studied, 4 of whom were colonised with Pseudomonas aeruginosa.

Intraductal hepatocellular carcinoma treated by intralumenal brachytherapy.

Hepatocellular carcinoma (HCC) rarely presents as biliary tract occlusion [1,2]. Intralumenal iridium-192 brachytherapy has been used to treat extrahepatic bile duct carcinoma and may be curative if the macroscopic tumour has been resected surgically [3]. We describe a rare event, a case of HCC presenting with biliary tract occlusion treated with intralumenal iridium-192 brachytherapy.

Does primary Streptococcus viridans pneumonia exist?

In 4 adult black patients admitted to an urban general hospital with community-acquired pneumonia, Streptococcus viridans alone was isolated from blood culture (first subculture), in the absence of any other positive microbiological finding. Sputum examination by Gram staining and culture in 3 cases was reported as negative. Echocardiography was performed in 3 cases and was normal, without evidence of endocarditis.

Unexplained hypertension during induction of a patient with phaeochromocytoma.

An unexplained hypertensive response during the induction of anaesthesia for phaeochromocytoma resection is described. This response was not accompanied by elevations in plasma catecholamine levels. It occurred despite heavy premedication and followed induction with etomidate, alfentanil, lignocaine, vecuronium and magnesium sulphate (MgSO4).